He said: "Normally, the cost calculations of assisted reproduction are limited to the cost of the treatment cycle alone. However, it seems clear to me that it is equally important to count the costs of hospitalisation, delivery according to the method of delivery, and neonatal care. This gives a much better view of the reality.
"The resulting figures show that multiple pregnancies have a very important economic impact, which should be considered together with the medical risks. Moreover, this study did not analyse the long-term costs, relating to cerebral palsy and handicaps that are much more frequent in multiple birth babies than in singletons. These figures reinforce the necessity of preventing their occurrence with an adapted policy on ART and stimulation regimen in other fertility treatments.
"Research shows that for healthy women, under the age of 40, who are ovulating normally, single embryo transfer, maybe over more than one cycle, achieves a similar pregnancy rate as transferring two or more embryos in one cycle – and with far fewer risks to the mothers and babies. With older women, or those with more problems, this is not necessarily the case. However, the money that is saved by avoiding the higher costs of multiple pregnancies in these younger women could be used instead to increase the numbers of cycles offered to women and enable more ART children to be born."
Dr de Mouzon, a specialist in public health and epidemiology and head of the human reproduction epidemiology team at the INSERM Unit U569, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France, said that in his country twin pregnancies had increased by 40% and triplet pregnancies by 300%. "Infertility treatments are the cause of 30% of all twins and 60% of all triplets born in France."
Using information from a number of sources including the French register on IVF, Fivnat, Dr de Mouzon calculated the cost in Euros of hospitalisation, delivery according to mode of delivery (e.g. non-interventional, delivery with the aid of instruments, and Caesarean sections), and neonatal care of ART babies born in the year 2000.
He found that the total cost per pregnancy was €4,614 for singletons, €12,730 for twins and €39,320 for triplets. These figures broken down showed that the cost of the pregnancy was €3,016 for singletons, €4,970 for twins and €9,104 for triplets, while the neonatal cost per baby was €1,598, €3,080 and €10,072 respectively.
When Dr de Mouzon applied these figures to the French IVF results of 2000 he found that the national costs of 6,246 ART singleton pregnancies was €26.8m, 2,099 twin pregnancies cost €26.6m, and 118 triplet pregnancies cost €4.6m.
"In total, the pregnancy cost was over €60m for the nation, with 8,463 pregnancies producing 10,798 babies. If all these pregnancies had been singleton pregnancies the cost would have been only €39m," he said. "Therefore, it would cost less to ensure that all women seeking fertility treatment had more cycles in which a single embryo was transferred, than only one or two cycles in which several embryos were transferred."
His research also showed the medical cost of multiple pregnancies. The average hospital stay increased from less than a day for a singleton birth to more than four days for triplets. The percentage of births delivered by Caesarean rose from 25% for singletons, to 51% for twins and 84% for triplets.
Dr de Mouzon told the conference that countries should consider economic costs, as well as medical, ethical and political implications when deciding on ART policies.
"It is important to consider economics when deciding on issues to do with public health and ethics, because costs can have an impact on whether a medical treatment is paid for by the country, through social security, or by the individual patients themselves. Equal access to high quality treatments is clearly considered as an ethical issue in our societies and, since money is not unlimited, cost is an important choice parameter, even if it is not the only one.
"It is also very important to know the economic impact of our attitudes in order to take the most appropriate decisions, and to allow the greatest access to patients who need infertility treatment."